Mortgage_Humphrey""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
� FOR DEDUCTION FROM ASSESSED VALUATION
:i'— �.• State Fam 63709 (R11 / 6-09)
�' � Presaibetl ty Departrnenl of Loral Govemrtrent Firexe
File Mark
INSTRUCTIONS: �,In\I 1
To 6e fi(ed in person w by mail with the CounryAudimr or Counry Rernrder of the counry where the property is 18�3�. 1 �
Fi6rg Dates: i) Real Pmperty Musf file dunng the year /or which Nie deduction is sought. �unry Auditor
2) Mo6de / ManufacNrcd Fbmes rw1 assessed as Real Prdperty: Must file dunng the hvelve (72J ms nths �'�7
before March 31 of each year the deduction is soughG C/76� /,t� Counry Recordu
�� � � /
SeereversesidefwaddrionalinsWCtionsand�alifications. enti r1111N Y AUDITOR
MP�n� (ou+ieror D(p+er re�ru side) _ '
setl vehie d mal p'operty as o!
i 1, artent year
whdl 6 h15 / h¢! C%df� Sh2fB 01
rlleyald9e�ripfpn'/��� — m'
(� 10 V
Mortgage / Contraa indebteEness u d as o(
Merch 1. ar2nt ynar
Name af mortgagee or conVact seller �/�
Address of rtnrtgagee w contracl seAer (number eM sveef, , sta:e, aiM ZIP code)
Name of assiyiee w oNu ovmer or hdder of morigage
Mdress of auignee (num0er aM sdee4 �Y. ua+e, and ZIP Code) � .
p�operty In any �
❑ Yes
Deauction aGW� in the amouN of.
20 I 20
Y8 `Yt�l Recofd num (
O
nfra�Y indebteCness unpaid as d Is Ihe
�qo, � ,�.� legal �
Yes Ll No
someone other Can spouse, uqicate wrtn wtrom
IS �f12 PfOPfII`f 111 QUCSGNI: Mf1U20`jAL52S5C�
❑ Real Roperty ❑ Nmually Assessed
��,.�..,,a�� Drawcr NO.....���......
No
Card NO. .....J�.. J.�.�.......
�— 1�, a�9.�
�
, reGUested m P�P�Y
20
irewa a cwmty nuartor I cwnq I oate (rtmM. mr. r�n
I/ We certify under Ne penalry of perjury that the above and foregoing information is We and cortea arM Nat the applican[ is a resident of Indiana and
owner! conVad buyer of ihe aforemenlioned property on date appiiration is filed.
�•i��
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�
�Wy eteated Power ot ARGmeY or by IC G7.7-12-0.7
person (numberaMSbeet,ciry,state,andLPCatle)
Da[e (rtpnfi, daY. Ye�